Bidirectional Glenn shunt in association with congenital heart repairs: The 11/2 ventricular repair

Background. The bidirectional Glenn shunt has been used to incorporate a sm aller tripartite ventricle into the circulation and create pulsatile pulmon ary artery flow. We reviewed our operative experience and assessed hemodyna mics of the bidirectional Glenn shunt in 1 1/2 ventricular repair or in con junction with other repairs of congenital heart defects. Methods. Between 1992 and 1998, 15 patients (mean age, 8.1 +/- 7.9 pears) h ad bidirectional Glenn shunt in association with repair of congenital heart defects. Eighty-seven percent had at least one previous operation. All pat ients had simultaneous or previous intracardiac repair and had bidirectiona l Glenn shunt to volume unload the small right ventricle (group A, n = 7), to unload the poorly functioning right ventricle (group B, n = 2), to redir ect superior vena cava-pulmonary venous atrial connection to treat cyanosis (group C, n = 2), or to unload the pulmonary left ventricle for residual i ntracavitary hypertension in patients with L-transposition of the great art eries, ventricular septal defect, and pulmonary stenosis (group D, n = 4). Intraoperative hemodynamic assessment was done in 2 patients in group A by selective use of inflow occlusion and flow probes. Results. All patients survived. Four patients had successful, concurrent ar rhythmia circuit cryoablation for Wolf-Parkinson-White syndrome (n = 1) or atrial reentry tachycardia (n = 3). Superior and inferior vena caval flow a veraged 36% and 64% of cardiac output, respectively. Postoperative superior vena caval pressure (n = 13) was 13.7 +/- 4.0 mm Hg with pulmonary arteria l flow pattern contributed by the ventricle in systole (pulsatile) and the superior vena cava in diastole (laminar). Conclusions, The bidirectional Glenn shunt is an effective adjunct to conge nital heart repair to treat pulmonary ventricular pressure-volume problems and anomalous superior vena caval to left atrial connections. (Ann Thorac S urg 1999;68:976-82) (C) 1999 by The Society of Thoracic Surgeons.